Use of a Virtual Reality Mask in the Reduction of Pain and Anxiety During in Utero Surgical Procedures

"The use of the virtual reality mask associated with local anesthesia during in utero fetal surgery procedures by fetoscopy in the treatment of complications of monochorionic twin pregnancies, could be an alternative to the use of intravenous remifentanil associated with local anesthesia. It would allow analgesia and reduction of patient anxiety, thus simplifying the procedure for both patients and surgeons.

The virtual reality mask is an innovative technique, alternative to pharmacological medicine that would allow, in addition to its action on pain, to reduce anxiety and thus increase patient satisfaction by improving their experience of a risky situation. The therapeutic effects of the virtual reality mask are based on a distractive effect with attentive capture, an emotional effect due to ludic aspect and positive suggestion, and a behavioral effect. The virtual reality mask has almost never been studied in a pregnant population, particularly in the context of in utero procedures associated with risks of fetal loss that further increase anxiety.

In utero fetoscopy is a potentially painful procedure, particularly at the beginning of the procedure due to the introduction of a fetoscopy trocar in the amniotic cavity through the patient's uterus. It also generates anxiety in mothers because of the risks associated with the pathology and the procedure. This research focuses on the use of a virtual reality mask in the reduction of pain and anxiety during in utero surgical procedures.

This is a prospective cohort study including pregnant women who have a complicated monochorionic twin pregnancy with an indication for fetal surgery (laser photocoagulation fetoscopy or Selective Termination of Pregnancy). The objective is to evaluate the success rate of the virtual reality mask for analgesia during fetoscopy in case of monochorionic twin pregnancies complicated. The success of the virtual reality mask for analgesia is defined by the absence of pain expressed by the woman (no administration of morphine (remifentanil)). The primary outcome is the administration or not of remifentanil. The secondary objectives are to evaluate firstly the variation in maternal anxiety when using the virtual reality mask, secondly the pain during the intervention and thirdly the maternal satisfaction.

The study is presented and proposed to the patient during the expert ultrasound examination by the obstetrician-gynecologist. Then the modalities are detailed by the anesthetist during the anesthesia consultation before the surgery. The presentation of the study and the signature of the consent can be done within two weeks prior to the procedure. The patient is included in the study after the consent is signed. During the anesthesia consultation, the patient is informed of the possibility of analgesia through a virtual reality mask, associated with local anesthesia. It is explained that in case of pain despite the virtual reality mask and local anesthesia, remifentanil administration remains possible. During the anesthesia consultation, the patient's initial state of anxiety is assessed by the APAIS score (Amsterdam Preoperative Anxiety and Information Scale). This is a validated score for the evaluation of patients' anxiety prior to a procedure. A score higher than 10 out of 20 indicates a high level of anxiety and helps to identify the most anxious patients. This score will therefore allow to evaluate the initial anxiety state by identifying two groups of patients according to their initial anxiety level: high (score strictly greater than 10) and normal (score less than or equal to 10), but also the mean initial anxiety score.